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Discussion

Was I wrong?

So last night my patient came back from OR. I took care of this patient the night before and during my shift and the previous shift, he had some episodes of ventricular bigeminy that would last about 30-40 secs before he would convert to sinus rhythm. The patient had multiple EKGs done and nothing was abnormal. Labs were WNL. So last niight I got the patient from OR and the CRNA or Anesthesia resident says to me, "Yeah, he had some bigeminy" to which I told him what had happened during my shift. Well, we had the patient laying flat and sure enough he had some bigeminy.

Now the part I left out is that the patient has a central line and I'm wondering if its a little too far in and its irritating the heart. The only time the patient has bigeminy is when I have him flat but when I sit him up, the bigeminy goes away. So the CRNA or Anesthesia resident wanted me to push lidocaine and I recounted my night before. I wasn't trying to be argumentative but I didn't want to push the lidocaine. I was just advocating for my patient. I know the patient. I spent 12 hours with the patient not him. But one of the other nurses I work with said I shouldn't have argued with the CRNA or Anesthesia resident.

What is your take?

Featured Replies

  • Author

Just wanted to add that the SICU residents are aware of the bigeminy and have not done anything further to address it.

Not only weren't you wrong, but that is our responsibility as nurses to bring our thoughts to the table about what is going on with our patients, advocate for them, use our critical thinking skills, etc. That is ridiculous of other nurses to say you shouldn't explain your concerns to the CRNA.

So, I think you did the right thing. However, it is a little unclear in the way you posted if you came right out and said "I think the central line is irritation his heart" or "This only happens when he lies flat, could it be the central line irritating his heart?". You said you recounted the night you had before but it's not clear if you recounted your reasoning. I hope you did.

When was the last CXR?

  • Author

I told him I thought it was the central line possibly being in too far. I wasn't sure at the time if it was too far in because I didn't have a chance to have the resident look at the xray.

What I meant to say was, the first night I took care of the patient, I noticed the patient had a couple of episodes of bigeminy when I laid him flat. Then it resolved when the HOB was elevated.

  • Author
When was the last CXR?

Did an xray when the patient came back. It said the distal port of the cental line was in the SVC. So maybe it's not the central line? I'm not sure. But he has only had the bigeminy one time since he came back from OR and that was when I had him laying flat.

Pushing lido would probably have been a waste of time and drug- bigemeny is a stable almost always stable and does not progress to worse things (it can but rarely). All in all I would have pushed a dose- whats it going to hurt. The CRNA would have felt better having treated the ectopy and the patient would have gotten rid of his bigeminy for 5-10 min. Lido is cheap and has almost no adverse effects in one IVP dose. You wasted more time discussing it that would have been used doing it.

Closed at OP request.

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